Underneath your tooth's outer enamel and within the dentin is an area of soft tissue called the pulp, which carries the tooth's nerves, veins, arteries and lymph vessels. Root canals are very small, thin divisions that branch off from the top pulp chamber down to the tip of the root. A tooth has at least one but no more than four root canals.

Why do I feel pain?When the pulp becomes infected due to a deep cavity or fracture that allows bacteria to seep in, or injury due to trauma, it can die. Damaged or dead pulp causes increased blood flow and cellular activity, and pressure cannot be relieved from inside the tooth. Pain in the tooth is commonly felt when biting down, chewing on it and applying hot or cold foods and drinks.

Why do I need root canal therapy?Because the tooth will not heal by itself. Without treatment, the infection will spread, bone around the tooth will begin to degenerate, and the tooth may fall-out. Pain usually worsens until one is forced to seek emergency dental attention. The only alternative is usually extraction of the tooth, which can cause surrounding teeth to shift crookedly, resulting in a bad bite. Though an extraction is cheaper, the space left behind will require an implant or a bridge, which can be more expensive than root canal therapy. If you have the choice, it's always best to keep your original teeth.

What is a root canal procedure?A root canal is a procedure done to save the damaged or dead pulp in the root canal of the tooth by cleaning out the diseased pulp and reshaping the canal. The canal is filled with gutta percha, a rubberlike material, to prevent recontamination of the tooth. The tooth is then permanently sealed with possibly a post and/or a gold or porcelain crown. This enables patients to keep the original tooth.

What is involved in root canal therapy?Once your general dentist performs tests on the tooth and recommends therapy, he or she can perform the treatment or refer you to an endo-dontist (a pulp specialist). Treatment usually involves one to three appointments.

First, you will probably be given a local anesthetic to numb the area. A rubber sheet is then placed around the tooth to isolate it. Next, a gap is drilled from the crown into the pulp chamber, which, along with any infected root canal, is cleaned of all diseased pulp and reshaped. Medication may be inserted into the area to fight bacteria. Depending on the condition of the tooth, the crown may then be sealed temporarily to guard against recontamination, or the tooth may be left open to drain, or the dentist may go right ahead and fill the canals.

If you're given a temporary filling, usually on the next visit it's removed and the pulp chamber and canal(s) are filled with rubberlike gutta percha or another material to prevent recontamination. If the tooth is still weak, a metal post may be inserted above the canal filling to reinforce the tooth. Once filled, the area is permanently sealed. Finally, a gold or porcelain crown is normally placed over the tooth to strengthen its structure and improve appearance.

What are the risks and complications?More than 95 percent of root canal treatments are successful. However, sometimes a case needs to be redone due to diseased canal offshoots that went unnoticed or the fracturing of a canal filing instrument used-both of which rarely occur. Occasionally, a root canal therapy will fail altogether, marked by a return of pain.

Natural tissue inflammation may cause discomfort for a few days, which can be controlled by an over-the-counter analgesic. A follow-up exam can monitor tissue healing. From this point on, brush and floss regularly, avoid chewing hard foods on the treated tooth, and see your dentist regularly.

Perhaps I've been lucky. My pulps have already been dead when treated, so from my point of view, the procedures have not been very dissimilar from any other treatment of cavities. Moreover, in all but one case, the crown could be shaped of amalgam or plastics, so it wasn't overly expensve either.

The last one was a rather large job, so I had a crown. Quite a lot of work, placing miniscule titanium and/or rubber spears as anchors in the cleared out canals. The worst part was the casting for the crown. The taste of the compound was gagging, and with the accumulation of saliva I was afraid that I would have to open my mouth and spit it all out. Well, I made it, and the dentist was very happy with the final fit.

The cost for a molar root canal is up to some USD 500 in Sweden according to Internet price lists. My last one, with a ceramics/gold crown, was some USD 850 (including X-rays, and one more cavity and a general cleaning).

Regarding dentures, I am positive that in any country, that would be a financially and perhaps also physically more painful way than having the root canals.

And I think you're right about the dentures, anders. A dentist once told me it's better to live with bad teeth than with dentures. This is the same guy that told me "ignore your teeth, they'll go away."

I understand that there are some reliable dentists in Mexico in the border cities (Laredo, Juarez, Mexicali, Nogales, and Tijuana). Maybe it would be cheaper in one of those.

anders wrote: . . . The worst part was the casting for the crown. The taste of the compound was gagging, . . .

Yes, part of the problem is the smell, sort of like burning rubber mixed with God knows what else. You have to breathe through your mouth instead of your nose so you don't smell it. My wife once gagged and vomitted so she had to endure it a second time. However, I don't recall that awful smell the last time or two I had one done. I think there are newer compounds used to take the impression that aren't rubber-based like I think the old ones were.

Another aspect of crown installation comes into play when your own tooth has lost too much of its own crown to provide a good surface to attach the new crown. Then the dentist will send you to an oral surgeon for a procedure known as "crown lengthening," which in reality is "gum shortening." The surgeon has to flap the gum back away from the tooth, remove some of the underlying tissue to expose more of the tooth, then fold the gum back. After it heals you can go back to have an impression taken for the final crown.

Many years ago I went to the Dental College in Baltimore for some work and the student who treated me said one of her friends one time made a Halloween costume which consisted of a fake tooth with a rubber dam around it and the heads of some old root canal files in it.

Been there, done that (unfortunately).

Regards//Larry

"To preserve liberty, it is essential that the whole body of the people always possess arms, and be taught alike, especially when young, how to use them." -- Attributed to Richard Henry Lee

Well, I have about 7 crowns. I say "about" because I honestly can't remember how many I've had at this point. Fortunately, I've only had 2 root canals. I remember those vividly. It was a pain that you could only imagine happening when someone is removing a nerve from inside your tooth. And this was after the numbing anaesthetic... I can't begin to fathom the pain that would have resulted from trying it without drugs.

One of them was beginning to abcess, so I had taken antibiotics before the work was done. Unfortunately, the infection was not wiped out, and horrible pain ensued after the gum started to puss out along where the root for that tooth was embedded. The other dentist at that practice had to lance the sore and let it drain.

But even after all this, I'd still rather have had root canals and crowns than have to deal with dentures!

not to mention the amalgam with the lead and mercury in it. I had two teeth removed and one old-fashioned cap he ground away all but the 'pulp' then blew air and ice water over that exposed nerve, He then had a completely wrong cap placed on it, wrong color, wrong size, and wrong shape. But still it's better than a root canal, or *SHUDDER* dentures! I think the worst part of going to the dentist besides the drill,oc, is that pickax they use to check the fillings.

KatyBr wrote:not to mention the amalgam with the lead and mercury in it. . . .

If your dentist is still using amalgam you better find a new one who uses composites. Mind you, the mercury was not absorbed by the body as I understand, but the newer composites are just better and set up faster. No more waiting an hour or more before you can eat.

Regards//Larry

"To preserve liberty, it is essential that the whole body of the people always possess arms, and be taught alike, especially when young, how to use them." -- Attributed to Richard Henry Lee

My (new) dentist is great! I never did go back to that one that took out my last wisdom tooth!

I get nitrous and novocaine! Just for a cleaning! She has specialized in Gold crowns and fillings and they are wonderful, not much more expensive than composite ones. I've got two more gold crowns to go. No more amalgam or composite for me, those gold crowns are as good as the day they were put in! I highly recommend them.

I love getting my teeth cleaned, but normal dental work is really hard to make fun!

Apo

'Experiments are the only means of knowledge at our disposal. The rest is poetry, imagination.' -Max Planck

tcward wrote:Oh, Katy, preach to me, sister! I totally agree about that "pickax"... Surely a device of the Devil!

-Tim

I can't believe this Tim, you are the only one I've met who agrees with me on the pickax. I have problems with that little hole for weeks, sensitivity etc, I'm afraid cavity germs will enter that hole.
Anyway up to my thirties I'd only had one cavity. my new dentist saw my mouth and decided I needed more lead and mercury, so he assigned me four more cavities. I asked to see what they looked like on the x-ray and was informed that they were too small to see on the x-ray. So, why did they feel they needed to dig to CHINA!???? after getting four new craters excavated in my mouth I received more gratutious poison (amalgam). nitrous makes me chatty, novacaine is limited, Dentists still scare me to death.

I wrote on the application form for my last dentist that I have a morbid fear of dentists and require nitrous just to sit back in the chair. When they called me into the chamber of horrors the first time, he cackled evilly and announced that the door hermetically seals and I would not be able to run away. But he did very good work, did not stock that 'barbed wire' dental floss that so many dental technicians-in-training seem maniacally determined to use during cleanings, did not recommend unnecessary procedures, and found ways to put people at ease.